Cardiovascular disease accounts for a large proportion of illness and disability in the elderly. The relationship between the high prevalence of asymptomatic atherosclerotic disease in the elderly and known risk factors for the development and progression of disease is not well understood. The proposed research will examine the interaction between presence of lower extremity arterial disease and other cardiovascular risk factors in a high risk group of elderly individuals with systolic hypertension. Specifically, this study will: 1. Describe the prevalence of intermittent claudication and asymptomatic lower extremity arterial disease as measured non- invasively by the ratio of ankle to arm blood pressure (ankle-arm index). 2. Examine the relationship between presence of disease with other risk factors including age and sex. 3. Correlate the extent of disease with subsequent cardiovascular endpoints including MI, sudden death stroke, and overall mortality. 4. Examine the effect of treatment of systolic hypertension based on baseline characteristics, including the ankle-arm index. This study is ancillary to the Multicenter Systolic Hypertension in the Elderly Program (SHEP) and will involve at least, 2,000 individuals of the 5,000 recruited for the main study. Subjects across at least 8 of 16 SHEP centers will undergo measurement of the ankle-arm index at two annual physical exams. Data will be collected locally after training and certification of technicians and forwarded to the University of Pittsburgh. Subsequent analyses will be done with baseline and follow-up data obtained as part of the SHEP protocol. This study is unique in its ability to use an objective measure of atherosclerotic disease and correlate it with data from a large cohort of elderly high risk subjects followed longitudinally.